Application of 2D-STE to evaluate the effect of Sacubitril valsartan on left atrial function in patients with early essential hypertension with left atrial enlargement
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摘要: 目的 观察沙库巴曲缬沙坦治疗原发性高血压早期伴左房扩大患者的降压疗效，并观察是否对左心房大小有逆转、对其功能有改善作用，同时与RAAS抑制剂进行比较。方法 纳入2022年4月1日—2022年10月1日就诊于宜昌市中心人民医院符合研究标准的原发性高血压早期伴左心房扩大的患者，随机分为观察组98例和对照组96例，观察组采用以沙库巴曲缬沙坦为基础的降压治疗方案，对照组采用以RAAS抑制剂为基础的降压治疗方案，2个月内将受试者血压降至目标血压水平，总计5个月后比较两组治疗前后血压、心率、常规超声指标包括左心房内径(LAD)、左心房最大容积(LAVmax)、左心房容积指数(LAVi)、二尖瓣血流E峰与二尖瓣环处侧壁和间隔舒张早期速度的平均值e’的比值(E/e’)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、二尖瓣舒张早期E峰与舒张晚期A峰峰值速度的比值(E/A)、二维斑点追踪成像(2D-STE)指标包括左心房收缩期应变及应变率(LAS-S及LASR-S)、左心房舒张早期应变及应变率(LAS-E及LASR-E)、左心房舒张晚期应变及应变率(LAS-A及LASR-A)及不良反应情况。结果 ① 在治疗后，观察组和对照组收缩压、舒张压、心率均显著下降(P<0.05)，但两组间的差异无统计学意义。②两组治疗前后LAD、LAVmax、LAVi、LVEF、IVST、LVPWT、LVEDD、E/A水平差异无统计学意义，两组的E/e’水平在治疗后均显著下降(P<0.05)，并且观察组的E/e’水平在治疗后下降显著。③在治疗后，观察组和对照组的LAS-S及LASR-S、LAS-E及LASR-E绝对值均显著升高(P<0.05)，并且观察组明显高于对照组(P<0.05)。相反，两组的LAS-A及LASR-A绝对值在治疗后均明显下降(P<0.05)，并且观察组低于对照组(P<0.05)。结论 通过观察2D-STE技术评价左心房功能的相关参数后发现，在血压控制相同的水平下，以沙库巴曲缬沙坦为基础的降压治疗方案，对患者左心房功能的改善效果优于以RAAS抑制剂为基础的降压治疗方案。
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关键词:
- 沙库巴曲缬沙坦 /
- 左心房功能 /
- 原发性高血压 /
- 二维斑点追踪超声心动图技术
Abstract: Objective To observe the antihypertensive efficacy of sacubitril valsartan in the treatment of patients with early essential hypertension with left atrial enlargement, and to observe whether there was a reversal of the left atrial size and an improvement of its function.Methods Patients with early essential hypertension with left atrial enlargement were included and randomly divided into 98 cases in the observation group and 96 cases in the control group. The observation group was treated with an antihypertensive regimen based on sarcobarbital valsartan, and the control group was treated with an antihypertensive regimen based on a RAAS inhibitor. The two groups were compared before and after treatment in blood pressure, heart rate, and conventional ultrasound indexes including: left atrial diameter(LAD), left atrial maximum volume(LAVmax), left atrial volume index(LAVi), mean value of mitral flow E peak divided by lateral wall and septal early diastolic velocities at the mitral annulus e'(E/e'), left ventricular end-diastolic internal diameter(LVEDD), left ventricular ejection fraction(LVEF), interventricular septal thickness(IVST), left ventricular posterior wall thickness(LVPWT), early mitral diastolic E peak divided by late diastolic A peak velocity(E/A), and two-dimensional speckle-tracking imaging(2D-STE) metrics including left atrial systolic strain and strain rate(LAS-Sand LASR-S), left atrial early diastolic strain and strain rate(LAS-Eand LASR-E), left atrial late diastolic strain and strain rate(LAS-Aand LASR-A), and adverse effects.Results (1) After treatment, systolic blood pressure, diastolic blood pressure, and heart rate decreased significantly in the observation and control groups(P<0.05), but there was no statistically significant difference between the two groups(P>0.05). (2) There was no significant difference in the levels of LAD, LAVmax, LAVi, LVEF, IVST, LVPWT, LVEDD, and E/A before and after treatment between the two groups(P>0.05), and the E/e' levels of the two groups decreased significantly after treatment(P<0.05), and the observation group's E/e' levels decreased significantly after treatment. (3) The absolute values of LAS-Sand LASR-S, LAS-Eand LASR-Ewere significantly higher in the observation and control groups after treatment(P<0.05), and the observation group was significantly higher than the control group(P<0.05). On the contrary, the absolute values of LAS-Aand LASR-Ain both groups decreased significantly after treatment(P<0.05), and were lower in the observation group than in the control group(P<0.05).Conclusion After observing the relevant parameters of left atrial function evaluated by 2D-STE technique, it was found that the antihypertensive treatment program based on Sacubitril valsartan was better than the antihypertensive treatment program based on RAAS inhibitors in improving the left atrial function of patients at the same level of blood pressure control. -
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表 1 两组一般临床资料的比较
Table 1. General data
例(%), X±S 项目 观察组(100例) 对照组(100例) χ2/t值 P值 男/女/例 43/57 51/49 1.285 0.257 年龄/岁 54.91±11.46 51.08±8.53 -1.519 0.252 吸烟史/例(%) 39(39.0) 45(45.0) 0.739 0.390 BMI /(kg/m2) 27.07±3.85 27.83±3.34 -1.498 0.136 BSA/m2 1.79±0.14 1.82±0.13 -1.646 0.101 高脂血症 12(12.0) 10(10.0) 0.204 0.651 高尿酸血症 9(9.0) 7(7.0) 0.272 0.602 心率/(次/min) 83.05±9.47 83.10±8.99 -0.038 0.970 收缩压/mmHg 155.16±9.05 155.95±9.67 -0.596 0.552 舒张压/mmHg 97.10±4.72 97.37±4.55 -0.412 0.681 合并用药/例(%) CCB类 27(27.0) 25(25.0) 0.104 0.747 利尿剂类 15(15.0) 18(18.0) 0.327 0.568 β受体阻滞剂 10(10.0) 12(12.0) 0.204 0.651 注：BSA：体表面积。 
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表 2 两组治疗前后血压心率比较
Table 2. Blood pressure and heart rate before and after treatment
X±S 指标 治疗前 治疗后 观察组(98例) 对照组(96例) P值 观察组(98例) 对照组(96例) P值 收缩压/mmHg 155.05±9.10 155.94±9.22 0.496 114.22±8.631) 115.69±8.311) 0.227 舒张压/mmHg 97.13±4.72 97.35±4.51 0.748 80.32±2.971) 80.44±3.101) 0.782 心率/(次/min) 82.91±9.51 83.11±9.01 0.883 72.97±4.611) 72.95±4.161) 0.962 与同组治疗前比较，1)P<0.05。
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表 3 两组治疗前后常规超声指标比较
Table 3. Routine ultrasound indexes before and after treatment
X±S 指标 治疗前 治疗后 观察组(98例) 对照组(96例) P值 观察组(98例) 对照组(96例) P值 LAD/mm 40.49±1.45 40.56±1.43 0.726 40.46±1.43 40.54±1.43 0.706 LAVmax/mm 60.04±4.47 60.74±4.88 0.299 60.00±4.49 60.68±4.95 0.320 LAVi/(mL/m2) 33.80±3.90 33.40±3.83 0.477 33.78±3.92 33.37±3.85 0.464 LVEF/% 71.17±3.25 70.88±3.02 0.524 71.22±4.00 71.07±3.46 0.778 IVST/mm 8.01±1.08 7.94±1.04 0.665 7.99±1.17 8.08±1.10 0.589 IVPWT/mm 7.90±1.00 7.87±1.03 0.831 7.90±1.03 8.01±1.26 0.560 LVEDD/mm 45.45±3.76 45.53±3.48 0.890 46.35±3.51 46.08±3.54 0.590 E/e’ 11.31±2.26 11.52±2.37 0.540 9.93±1.761)2) 10.86±1.741) <0.010 E/A 0.69±0.22 0.72±0.24 0.626 0.67±0.24 0.72±0.23 0.099 与同组治疗前比较，1)P<0.05；与对照组治疗后比较，2)P<0.05。
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表 4 两组治疗前后2D-STE指标比较
Table 4. 2D-STE indexes before and after treatment in two groups
X±S 指标 治疗前 治疗后 观察组(98例) 对照组(96例) P值 观察组(98例) 对照组(96例) P值 LAS-S/% 29.00±1.25 29.29±1.45 0.150 33.89±1.501)2) 31.44±2.371) <0.001 LAS-E/% 13.02±1.68 12.85±1.75 0.487 17.75±1.641)2) 15.70±2.081) <0.001 LAS-A/% 14.96±0.98 14.77±1.11 0.211 14.03±1.171)2) 14.37±1.231) 0.046 LASR-S/s-1 1.47±0.30 1.53±0.29 0.118 2.14±0.491)2) 1.92±0.581) 0.004 LASR-E/s-1 -1.16±0.23 -1.14±0.16 0.635 -1.91±0.301)2) -1.58±0.371) <0.001 LASR-A/s-1 -3.08±0.45 -3.15±0.43 0.249 -2.17±0.251)2) -2.27±0.341) 0.024 与同组治疗前比较，1)P<0.05；与对照组治疗后比较，2)P<0.05。
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